In the Maternal Health Practices and Child Development (MHPCD) Project, we have found that prenatal alcohol exposure negatively affects the growth, morphology, behavioral, and cognitive development of children through the age of six. It is important to evaluate the impact these deficits will have on the continued development of the children and to determine whether additional effects will be detected at older ages. This information is necessary for counseling parents and educating pregnant women, as well as for identifying and treating the problems of school-aged children who have been exposed to alcohol prenatally. The MHPCD project is a prospective epidemiologic study of the pregnancy outcomes of 650 women. It is one of few studies that have followed a cohort from early in pregnancy through the child's sixth year. The women who were selected for the study represented the entire spectrum of alcohol use, although the majority were moderate drinkers and moderate users of other substances. Thus, we have a unique opportunity to study alcohol effects across the entire exposure curve while concentrating on assessment of the effects of moderate levels of drinking during pregnancy. The next phase of this longitudinal study will assess growth, morphology, cognitive development, behavior, motor skills, and neuropsychological performance of the children at age ten. We will determine whether the observed effects of prenatal alcohol exposure persist as the children mature and examine the way in which environmental factors moderate the effects of prenatal alcohol exposure. New measures have been added to the child assessment to evaluate these relationships in greater depth and to detect new effects that may become evident as the children mature. We anticipate that additional effects of prenatal alcohol exposure will be detected at older ages as more complex demands are made on the children for mastery of increasingly difficult levels of cognitive tasks and motor skills.